[Long-term steroid therapy in children: is adjunct therapy relevant in nephrotic syndrome?].
The impact of glucocorticoids on bone is specifically relevant in children exposed to a long course of treatment. Corticosteroids lead to a decrease in bone formation, mainly by osteoblastic inhibition in trabecular bone. They also play an indirect role in bone metabolism through systemic actions, such as bone maturation delay, hypogonadism, pubertal delay, and IGF1 inhibition. A systematic review of the literature was conducted. We found 12 clinical trials of interventions including calcium, vitamin D, growth hormone, calcitonin, and bisphosphonates for preventing bone disease in children receiving steroid therapy. There were few randomized controlled trials (n=7), with a limited number of patients, so that a meta-analysis could not be performed. Calcium and vitamin D supplementation may, however, have a beneficial effect on bone in children with nephrotic syndrome receiving long-term steroid therapy. We, therefore, recommend routine vitamin D supplementation, use of steroid-sparing protocols, and global prevention of risk to bone (adequate calcium intake, sun exposure, and physical activity).
Bacchetta
J
J
Service de néphrologie et rhumatologie pédiatriques, centre de référence des maladies rénales rares, hôpital Femme-Mère-Enfant, université de Lyon, 69677 Bron, France.
Harambat
J
J
Cochat
P
P
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001847:Bone Diseases / Q000139:chemically induced / Q000517:prevention & control; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism; D002118:Calcium / Q000378:metabolism; D017024:Chemotherapy, Adjuvant; D002648:Child; D006801:Humans; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D010758:Phosphorus / Q000378:metabolism; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D010758:Phosphorus; D002118:Calcium